Sleep disturbance and multimorbidity: a cross-sectional and longitudinal study in the Knee Pain and related health in the Community (KPIC) cohort

Thompson, Will; Swain, Subhashisa; Coupland, Carol; Rees, Frances; Courtney, Phil; Hall, Michelle; Ferguson, Eamonn; Walsh, David A; Valdes, Ana M; Morriss, Richard; Doherty, Michael; Zhang, Weiya

Abstract

Study Objectives
To examine whether there is a temporal association between sleep disturbance and multimorbidity.

Methods
We performed a cross-sectional and longitudinal observational analysis in people aged 40 years or more, recruited from the Knee Pain and related health in the Community (KPIC) cohort study. The primary exposure was the Sleep Problems Index II score in tertiles measured at baseline. The primary outcome was count of chronic conditions developed in 5 years. Pain, low mood and anxiety were measured at 2 years as mediators. Poisson regression was used to calculate adjusted relative risk (aRR) and 95% confidence intervals.

Results
We included 4488 participants in the cross-sectional analysis at baseline and 1941 in the 5-year longitudinal analysis. At baseline, the aRRs for prevalent multimorbidity were 1 (reference) for tertile 1, 1.09 (95% CI; 1.01-1.18) for tertile 2, and 1.21 (95% CI;1.11-1.32) for tertile 3 of the sleep disturbance score (p for trend <0.001). Of the total association between sleep disturbance and multimorbidity, 14% (95% CI; 9% to 19%) was mediated by pain and 7% (95% CI; 2% to 13%) by low mood. In the 5 year follow-up, the aRRs for incident multimorbidity were 1 (reference) for tertile 1, 1.12 (95% CI; 0.98-1.28) for tertile 2 and 1.25 (95% CI; 1.06-1.47) for tertile 3 (p for trend 0.007). Of the total association between sleep disturbance and multimorbidity, 10% (95% CI; 2% to 18%) was mediated by pain.

Conclusions
Sleep disturbance is associated with multimorbidity. The association is dose-dependent, temporal, and partially mediated by pain.

Citation

Thompson, W., Swain, S., Coupland, C., Rees, F., Courtney, P., Hall, M., Ferguson, E., Walsh, D. A., Valdes, A. M., Morriss, R., Doherty, M., & Zhang, W. (in press). Sleep disturbance and multimorbidity: a cross-sectional and longitudinal study in the Knee Pain and related health in the Community (KPIC) cohort. SLEEP Advances, https://doi.org/10.1093/sleepadvances/zpaf039

• Journal Article Type: Article
• Acceptance Date: Jun 3, 2025
• Online Publication Date: Jun 11, 2025
• Deposit Date: Jul 14, 2025
• Publicly Available Date: Jul 14, 2025
• Journal: SLEEP Advances
• Print ISSN: 2632-5012
• Electronic ISSN: 2632-5012
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1093/sleepadvances/zpaf039
• Public URL: https://nottingham-repository.worktribe.com/output/51612052
• Publisher URL: https://academic.oup.com/sleepadvances/advance-article/doi/10.1093/sleepadvances/zpaf039/8160275